Kineret — Medica
Rheumatoid Arthritis – Patient is Currently Receiving Kineret
Preferred products
- Actemra subcutaneous
- Tyenne subcutaneous
- Enbrel
- adalimumab-adbm
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Rinvoq
- Xeljanz tablets
- Xeljanz XR
Initial criteria
- Patient meets the standard Inflammatory Conditions – Kineret Prior Authorization Policy criteria
- Patient meets ONE of the following (a or b): a) Patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, and Xeljanz/XR [documentation required]; OR b) Patient has been established on Kineret for at least 90 days and prescription claims history indicates at least a 90-day supply was dispensed within the past 130 days, or if claims history is not available, verified by the prescriber that therapy has been received via paid claims
Approval duration
1 year